Kentucky ranks 2nd in disability among states, with chronic low back pain (CLBP) as a major disability, especially in our rural areas. In the last few years the medical use of opiate medications has significantly increased. Their use has complicated treatment greatly, with addiction rates and misuse skyrocketing. Kentucky and U.S. health care providers need alternative and effective treatments. Following NCCAM strategic research recommendations, this study will investigate health services outcomes of complementary and alternative medicine (CAM) therapies in an existing primary care practice-based research network (PBRN). The Kentucky Ambulatory Network (KAN) is the partnering PBRN. Patients with CLBP are often willing to try therapeutic options outside the conventional medical spectrum. Massage and relaxation therapies have demonstrated fairly good efficacy in controlled trials but their effectiveness in the "real world" of primary care is only beginning to be evaluated. The long-term goal of the proposed project builds on the foundation of these two established therapies to improve treatment of chronic low back pain (CLBP) in primary care practices. Two alternative (CAM) therapies, progressive muscle relaxation (PMR) and clinical massage therapy (CMT), will be studied. The short-term objectives of the proposed project are to: (1) examine outcomes of CAM for patients with CLBP referred from primary care practices, and (2) better understand physician decision-making to recommend CAM therapy for CLBP. Specific Aim 1 will evaluate improvement in health-related outcomes for patients with CLBP when referred to PMR or CMT from primary care. Specific Aim 2 will explore selected factors in primary care physicians'decisions to recommend CAM therapy to these patients. The proposed study is unique in that it addresses "real life" clinical situations and decision-making in both urban and rural clinical practices within an existing PBRN. Should such CAM referral prove successful for ameliorating CLBP, it would provide relatively low cost, non-addictive treatment options for inclusion in the repertoire of primary care physicians. PUBLIC HEALTH RELEVANCE: The "CAM Referral and Outcomes: Chronic Low Back Pain in Urban and Rural Primary Care" project will investigate clinical and patient-oriented outcomes of CAM therapies in an existing practice-based research network (PBRN). For patients with chronic low back pain, we will examine the outcomes of clinical massage therapy and progressive muscle relaxation when referred by primary care physicians, as well as selected factors in the physicians'decisions to recommend these therapies.